MD REVIEW

Bloodless Leukemia Treatment Options

Life in The Balance

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“Your child is clinging onto life.” The doctor might as well rip your heart out and throw it against the wall. That’s what it feels like. The instinctive parental response is, “What can you do to save him? You must be able to do something!”

Emotions force tears through the eyelids of the most stoic parents when a disease is difficult to cure. Complexity increases when a family’s religious convic­tions preclude tradi­tional remedies. This is some­times the case with leukemia. But there is reason for hope.

What Is Leukemia?

There are four major components of blood: red cells, white cells, platelets, and plasma. White blood cells defend the body against infections. Leukemia is a cancer within the blood cells and bone marrow. The four primary types of leukemia have several subtypes.

Fast-growing acute leukemia varia­tions contrast slow-growing chronic leukemia. With acute myeloid leukemia, bone marrow circulates under­developed white blood cells. These defec­tive white blood cells are unable to fight off infection. There­fore, the body becomes suscep­tible to disease.

Four Main Types of Leukemia

  • Acute lymphocytic leukemia (ALL)
  • Chronic lymphocytic leukemia (CLL)
  • Acute myeloid leukemia (AML)
  • Chronic myeloid leukemia (CML)

Subtypes include: Hairy cell leukemia (HCL), a sub­type of CML; Acute pro­myelo­cytic leukemia (APL), a sub­type of AML; Myelodys­plastic syndromes (MDS) is reclassi­fied as AML with myelodysplastic features when blood or bone marrow blasts reach or exceed 20%.

Leukemia cells

Leukemia can occur at any age. Adult-onset leukemia is more preva­lent above age 55. Among adults, the most com­mon types are CLL (35%) and AML (32%). ALL accounts for 75% of pediatric leukemia cases.

Leukemia Manifestations

Symptoms include fever, persistent fatigue, easy bruis­ing, chills, swollen lymph nodes, and tiny blood spots on the skin. Bruising is the bleeding of the small blood vessels under­neath the skin. This is a common symptom of blood cancer. Excessive bleeding and bruising occurs because there are not enough platelet cells to plug blood vessels.

Leukemia Complications

Diagnosis and care of leukemia cancer combines oncology, hematology, immunology, pathology, and other medical specialties. As cancerous blood travels through the blood­stream and lymph nodes, damage can spread to the brain, heart, and other organs.

Leukemia patients are at higher risk of develop­ing cardiac dysfunc­tions. The incidence of congestive heart failure is more common in leukemia cancer. Cardiac altera­tions in leukemia are due to a high amount of cytokines released to fight blood cancer.

Conventional Leukemia Treatment

Leukemia Treatment Without Blood

Leukemia shortens lifespans regardless of the remedy. The hope is that the cancer goes into remission for a lengthy duration. But this is not the case for some patients, even with the best care.

Using the most aggressive treatment, the average 5-year survival rate for all types of leukemia is about 66%. Results vary among cancer types. The average 10-year APL survival rates are 80–90% according to one study.

Treatment for leukemia depends upon the type, patient age and general fitness level. Common options include chemotherapy, radia­tion therapy, and stem cell transplant. The major side effect of chemotherapy is low blood count (fewer red or white blood cells or less platelets in your body than normal). There­fore, leukemia patients routine­ly receive blood transfu­sions during chemo­therapy.

Alone or in combina­tion with other cancer therapies, immunolo­gists may suggest immuno­therapy. This helps the immune system fight leukemia. Side effects for each treatment can range from mild to severe.

Transfusion Alternatives For Leukemia

Millions of people reject blood transfusions due to their religious convic­tions or other reasons. With the concern of decreasing survival, some medical facilities deny treat­ment to patients who refuse blood transfusion. Religious patients do not consider themselves to be martyrs. They seek the best care avail­able without blood transfusions.

Some novel transfusion-free options offer hope for blood cancer. Arsenic trioxide and all-trans retinoic acid are two novel drugs in the bloodless treat­ment paradigm of acute promyelo­cytic leukemia (APL). Dan Douer, M.D., director at the USC/Norris cancer center, has hailed these drugs as a revolution in the treat­ment of blood cancer.

Another drug called azacyti­dine has shown potential in the treat­ment of APL. Complete remission was observed in a Jehovah’s Witness patient who was treated with azacytidine therapy.

A retrospective study of 498 patients revealed erythro­poietin (synthe­tic or blood frac­tion) was effec­tive in 364 patients for optimizing red blood cells for cancer therapy delivery. Treat­ment paradigms are shifting with the introduc­tion of new and better drugs. Not all facilities have the expertise to offer non-blood­ medical manage­ment.

Currently, APL is the main type of leukemia with successful bloodless treatment options. But there is hope that the novel drugs can pave the way for a complete bloodless treatment of all leukemia.

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